The Conflict Box

Elderly parents and their adult children caregivers often disagree on care-related issues. Caregivers urge their parents to accept help, move to an assisted living facility, or surrender the car keys. Parents resist.

It’s an all-too-common family dynamic. When adult children looking out for their elderly parents’ well-being are met with resistance, stubbornness and outright hostility, what’s really going on?

We see this dynamic so often that we’ve developed a model to explain it. We call it the Conflict Box.

The horizontal black line is the capacity line that represents a continuum of the elder’s mental and physical capacity. The left-most point means no loss of function/capacity; the far right-most point indicates death.
The vertical green line on the left represents the elder’s preferences, which include maintaining their independence and the ability to control how they live their lives. The vertical blue line on the right represents the caregivers’ preferences for the elder’s safety, security and quality of care.

When an elder’s capacity is high, his or her preferences matter most. As the elder’s capacity declines, his preferences decline in priority (green diagonal line from top left to bottom right) and the caregivers' preferences predominate (blue diagonal line from bottom left to top right). If an elder has moved to the far right on the capacity line, he or she doesn't get to decide where to live or how money is spent. Those important decisions are left to the caregivers.

The red box in the center –the Conflict Box—depicts the time when problems are most likely to happen. Differences in perception of the elder’s capacity are at the root of these conflicts.

In one common scenario, the elder’s capacity (let’s say it’s Mom) has declined to the point where caregivers’ preferences start to impinge on her desire for independence. Mom may be unwilling or unable to acknowledge this decline in capacity and is operating under the illusion that she is a healthy older person with few limitations. Mom is in denial. To her children, however, there is ample evidence that she’s not managing as well as she once did. Mom views her caregivers’ requests as unwanted and unwarranted intrusion. Conflict ensues.

When adult children come our office to discuss the future of an elderly parent who isn’t doing so well, they will often say they need to consult with that parent before making a decision to implement the plan we’ve recommended. The kids come to see us because they know that their Mom’s capacity is diminishing, yet they interact with her as though her capacity were undiminished. In this situation, it’s the kids who are in denial. And when a disaster happens (as it inevitably does), the kids feel blindsided.

A third scenario involves an elder who is truly functioning as a healthy older person yet the children think he or she is losing capacity.

Conflict is inevitable when differing perspectives collide. Once the illusions are confronted, the storm usually passes.